500 MEDICAL JURISPRUDENCE Symptoms.—In cases of acute poisoning the symptoms usually appear within half an hour, but they may be delayed for several hours, especially in those cases where arsenic enters the system by channels other than the mouth, e.g. by the rectum or vagina or by its application to the skin or to ulcerated or diseased surfaces. The patient first of all complains of a feeling of faintness, depression and nausea, and then severe burning pain in the throat and stomach which increases on pressure, jntense^thirst and severe | vomiting are the constant symptoms. The vomited matter at first contains p the ordinary contents of the stomach, but later contains mucus and blood in streaks or in spots. The colour is dark-brown, yellow, green, or bluish, on account of yellow sulphide of arsenic, or indigo of arsenic, being mixed with bile. Rarely, vomiting may be absent. Robertson Milne describes the case of a Mahomedan male who after a meal took in mistake for chalk a tola (180 grains) of white arsenic. He had marked salivation and burning pain in the stomach but no vomiting. He passed two or three motions, became rapidly unconscious and died in 2 hours and 35 minutes.2 Purging is; usually accompanied by tenesmus, pain, and irritation about the anus. The stools are expelled frequently and involuntarily, and are dark coloured, foetid and bloody, but later become colourless, odourless, and watery, resembling the " rice water stools of cholera". Thejorine is sup- pressed or scanty and contains blood. Tterejjs pain in micturition. There may be severe cramps in the calf muscles, as well as other muscles, wfcch usually commence with purging. The patient becomes restless, greatly prostrated and passes into a state of collapse. The" surface becomes cold and clammy, and the face is pale and anxious but later becomes cyanosed. The eyes are sunken. The pulse is feeble, irregular and frequent. The respira- tions become laboured. Lastly, convulsions and coma precede death. The intellect generally remains clear to the end. When a very large dose is taken death may occur rapidly from shock without producing any symptoms. On the other hand, a large quantity often causes intense vomiting which expels the arsenic from the stomach before it is absorbed and thus the patient's life is saved. Several such cases8 had occurred in the Punjab during 1925. Narcotic Form.—In this form the gastrointestinal symptoms, if present at all, are very slight. The patient complains of giddiness, formication and tenderness of the muscles, and becomes delirious, but soon passes into a state of coma, and dies without regaining consciousness. The pupils are dilated, Sometimes, there is complete paralysis of the extremities. At about 8 p>m. on the 24th July 1906, a convict compounder in Port Blair was found to "be groaning and having violent spasms, being quite unconscious, just after he went to bed after taking some milk. This condition lasted only a few minutes after which he died. There was no vomiting or purging. Post-mortem examination showed inflammation of the mucous membrane of the stomach and small intestine with large patches of punctiform haemorrhages. The large intestine was healtfey and contained semi-solid faeces. Arsenic was detected in the viscera.—Bengal Chemical Examiner's Annual Report, 1906; Ind. Med. Gaz., Oct. 1907, p. 393. Sub-acute Form.—This is the ^condition which usually results when arsenic is administered in small doses at repeated intervals with the object of causing death by gradual prostration. The symptoms are first dyspepsia, cough and tingling in the throat, then vomiting, purging with abdominal pain and tenesmus, foul tongue, dry and congested throat, and a feeling of depres- sion and languor. The motions are bloody. The symptoms of neuritis are more pronounced. The patient complains of severe cramps in the muscles, which are extremely tender on pressure. He is very restless and cannot 2. Ind. MeoL Gaz., 1902, p. 209. 3. Punjab Chemical Examiner's Annual Report, 1925, p. 7.